• Five costly conditions to watch
• Workplace-training programs struggle to bridge skill gaps
• Senate committee passes health reform bill
• Employers use social networking to maximize wellness program participation
• Wisdom teeth
• Employers stumble on disability policies
• News You Can Use: Relax, mental health parity won't cost as much as you think
• Tip of the Day: 'Get out of the babysitting business'
• Pitfalls await employers adopting partner benefits
• Paying employees to lose weight
• Exercise Corner: Going Green: Tips for Eco-Friendly Exercise
• Recipe Corner: How to Make a Watermelon Basket Party Decoration Recipe

Is your self-funded health plan ready to handle some of the most expensive medical conditions?

Many employers choose to self-fund their medical plan because of the significant flexibility, enhanced control over benefit design and potential cost savings they afford over conventional fully-insured health plans. The tradeoff, of course, is that under a self-funded plan, the employer takes on the direct financial risk of providing the benefits and is ultimately responsible for paying claims.

While companies that opt for a one-size-fits-all, fully insured plan may not focus as much on particular medical conditions, companies that self-fund need to be keenly aware of the unique health characteristics of their employee base. Yet, when it comes to which medical conditions pose significant financial risk for self-funded plans, many employers remain in the dark.

As a registered nurse and medical risk consultant for a leading stop-loss insurance provider, I regularly work with employers, third-party administrators, hospitals and health care providers on a variety of complex medical conditions affecting self-funded medical plans. The job of our entire team of medical risk consultants is to utilize our health care expertise to reduce the claims experience on behalf of employer group clients.
Based on the team's experience, I have assembled a list of five common conditions that represent some of the more costly and complicated treatments particular to self-funded health plans.

1. Kidney disease

According to the Centers for Disease Control and Prevention, nearly one in six adults has chronic kidney disease. The two main causes of chronic kidney disease are diabetes and high blood pressure. Rather than exhibiting a rapid onset, kidney disease tends to follow a progression through five stages: slight damage, mild decrease in function, moderate decrease in function, severe decrease in function and end-stage kidney failure.

High costs usually take hold in stage five when dialysis is imminent. Dialysis costs on average are approximately $25,000 per month. Annually, costs can vary from $200,000 to $400,000 depending on network arrangements, availability of care centers and the dosages of the high-cost supportive drugs typically administered.

As in the broader population, the proportion of employees with high blood pressure or diabetes is growing. This increases the probability of kidney-related problems and other health issues arising among plan participants. Yet, many self-funded plans are not set up to address all phases of the disease. For example, plans may not be able to handle proactive kidney disease case management aggressively enough at an early phase, which can lead to more claims exposure at more severe stages later on.

The process for lowering charges should begin before the first bills arrive. Within the plan, establish advance screening, notification processes and assessments for kidney conditions. Plan language that requires precertification and delineates working with effective cost-containment partners seems to get the best results for preserving patients' lifetime benefit maximums and conserving fund dollars.

Early identification of the condition also can greatly reduce costs over time. Chronic kidney problems often can be delayed or even avoided through preventive procedures, early intervention, and patient education and counseling. Aggressive disease and case management can in some cases slow the progression to kidney failure.

2. Hemophilia

Hemophilia is a rare genetic disorder that prevents the blood from clotting normally. Research shows 60% of the hemophilia population falls into a severe category requiring advanced therapies several days a week. Currently, there is no cure for hemophilia. The main treatment currently available is a lifelong infusion of replacement "blood clotting factors."

Hemophilia consistently comes in near the top of claims among the employer groups we work with. We have found that, on average, treatment costs have an annual run rate of over $300,000 per individual.

Treating hemophilia is not just expensive, but it is a condition where insureds tend to burn through the lifetime benefit maximum at a rapid rate. Because of the repetitive and intense treatments, including infusions, it is not uncommon for hemophiliacs to reach their lifetime benefit maximum while still in early childhood. Without adequate stop-loss coverage, this can put significant pressure on reserves and potentially affect the company's overall capital position.

Hemophilia treatment is expensive in large part due to the drug component. As a result, make your pharmacy providers compete on price. If your plan does not include more than one preferred pharmacy provider, look to build in at least one or two additional options.

As soon as a hemophilia case is identified and before paying claims, reach out to your pharmacy benefit manager to see about negotiating deeper discounts beyond standard PPO levels. If you are not sure how, your medical stop-loss carrier should be able to go to work on the discount for you. We recently did this on behalf of an employer and found it would result in an average savings of $147,840 per year.

3. Transplants

Transplant procedures continue to improve with dramatic, often life-saving, results for patients. While stem cell/bone marrow, liver and kidney transplants are among the most common, physicians are now able more than ever before to effectively treat more medical conditions using transplants. According to Milliman, the usage of virtually every type of transplant surgery increased from 2004 to 2008. Improved transplant availability, however, comes at a hefty price.

Transplants remain one of the most complicated and expensive of all medical procedures. Reports show that common liver-kidney transplants rack up average billed charges of $760,000 and, in our experience, stem cell transplants and the accompanying care cost on average between $350,000 and $600,000.

Transplants are truly uncharted waters for health insurance. All types of plans, self-funded included, struggle with how to accommodate this rapidly growing treatment. Employers can pay a high price if they fail to take into account the potential future claims exposure from expanding transplant therapies when drawing up their plan design.

Make sure your plan provides access to at least one transplant network. With demand outstripping supply, this can save both time and money in securing a transplant for participants. Also, require external peer review. We typically contract with at least three different transplant facilities for clients in order to improve responsiveness and choice, while also reducing risks and establishing greater discount leverage.

4. Specialty drug treatments

Pharmacological and biologic innovation is spurring a myriad of specialty drugs designed to treat serious health conditions such as cancer, immune deficiency disorders and metabolic syndromes. Some of these wonder drugs hold the promise of unprecedented improvements in patient health and survival rates. Cutting-edge drugs for advanced cancer treatments are likely to be among the key cost drivers for this area going forward.

However, specialty drugs have also begun to find broader application as it relates to less life-threatening conditions, such as rheumatoid arthritis.

Specialty drugs already account for roughly a quarter of outpatient pharmacy expenditures, according to CuraScript's Specialty Pharmacy Management Guide and Trend Report, and that proportion is expected to continue growing. On the patient side, prices can range from $5,000 to more than $300,000 a year, according to a recent AARP report.

Most plans have benchmarked and forecast benefits using historical utilization data. Yet, these new specialty drugs look to have very different administration and cost characteristics than more conventional prescriptions. In addition, unlike other drug categories, these treatments are less likely to have available a generic equivalent or substitute treatment option.

Find vendors with expertise in this area and get them involved early on to collaborate with the physicians handling the treatment plan. Verify that you have access to specialty drug consultants through your TPA or medical stop-loss insurer. They should be able to make available a team of cost-containment experts to help whittle down direct charges for these drugs and other treatments as well. They can also ensure specialty drugs are being administered appropriately and in fact going to those patients who really require them.

Drugs approved by the FDA are for specific conditions with specific dosages. If dosages and frequencies do not concur with FDA guidelines for a particular drug, questions about experimental or investigational uses may come into play.

As for plan design, prescription drug plans do not usually cover specialty drugs and infusion therapies, so include plan wording that prevents constant exceptions. Clearly define how each coverage area will accommodate these treatments so as to avoid specialty drug claims spilling over.

5. Extreme premature births

Every year, millions of babies are born smaller and sooner than expected. One in eight babies born in the U.S. fall into the preterm classification of being born before 37 weeks, and the number of extreme premature births is growing. Since the United States began keeping records of premature infants in 1981, the trend has been on a steep upward path, increasing 30% by 2005.

A baby born at 24-to-25 weeks gestation, who is small enough to fit into the palm of your hand, is likely to cost more than $1 million dollars. Even after plan discounts, actual claims can easily run between $700,000 and $900,000.

Physicians have difficulty both in predicting preterm births and preventing the event, as it occurs in women who get prenatal care as well as those who do not. This limited ability to foresee the condition, coupled with frequent failures by hospitals to provide timely notification to plans, complicates expense management under a self-funded plan.

The newborns often require extended stays in neonatal intensive-care units with highly-specialized medical care, but there are few such qualified facilities available, and they operate at a high cost. These early births often result in later complications, including congenital heart disease, mental retardation, cognitive defects and cerebral palsy. Overriding all of this is the fact that, when the survival of a precious newborn is at stake, it is obviously an emotionally charged situation for the family and all parties involved.

Find a specialty vendor with a record of successfully working in partnership with hospitals that have a record in effectively managing preterm infant care. Such a vendor will often partner with the neonatologist, have expertise in medical management for these fragile babies and provide dedicated hospital discharge planning. This interaction even involves direct physician-to-physician consulting.

It also is a good idea to have a case manager at your disposal with experience in neonatal intensive nursing, again either through the TPA or medical stop-loss carrier. Should further health complications emerge down the road, this case management can be quite helpful in ensuring proper diagnosis and treatment for premature birth-related conditions and in reducing the likelihood of unnecessary or duplicate tests and procedures.

Source: EmployeeBenefitNews.com, July 1, 2009

While the jury is still out on the long-term consequences of the recession on the labor market, one thing holds certain: a skilled workforce remains essential to a company’s success.

Yet U.S. employers report that many new hires lack critical-thinking and creativity skills, and that their workforce-readiness programs are only “moderately” or “somewhat successful” in correcting those deficiencies.

According to the report, ‘The Ill-Prepared U.S. Workforce: Exploring the Challenges of Employer-Provided Workforce Readiness’, employers’ inability to detail their spending on remedial programs makes it impossible to assess the true costs of an ill-prepared workforce to their bottom line.

The report is the brainchild of Corporate Voices for Working Families, the American Society for Training & Development, The Conference Board, and the Society for Human Resource Management.

“It doesn’t make any difference if you're operating a business in Mumbai, Beijing or New York - the number one challenge facing every organization is finding and growing skilled talent,” says SHRM CEO and President Laurence O'Neil. “HR professionals are helping bridge the gap, finding ways to give employees the skills they need to add value and to be more valued. This isn't just an HR challenge, but a bottom-line global business problem,” he adds.

The report’s findings reflect survey responses of 217 employers on their training of newly hired graduates of high school and two- and four-year colleges. Conducted in 2008, the poll included employers in manufacturing, financial services, non-financial services, education, government, and other non-profits.

“The results of this study demonstrate how critical it is for companies to be more strategic and focused on efforts such as providing internships and working in partnership with community colleges on workforce readiness initiatives to prepare new entrants before they enter the workplace,” says Donna Klein, executive chair of Corporate Voices for Working Families. “It is a losing strategy for employers to try to fill the workforce readiness gap on the job. They need to be involved much sooner to prepare new employees to succeed,” she adds.

The report highlights five case studies of successful workforce readiness programs run by Bank of America and Year Up, CVS Caremark and TJX Companies, Harper Industries, Northrop Grumman, and YUM! Brands.
Other findings from the report:

• A culture committed to training and thorough job-readiness screening will set up strategic partnerships with local colleges, and a focus on integrating training with job-specific skills and career development.
• Employers should constantly re-evaluate the program to align training with company needs.
• Employers should track the cost and quality of training programs. 
• Organizations should also help focus philanthropic dollars and public-policy discussions on the need to link K-12, technical-school and college education to the workforce readiness skills that employers need.

Source: EmployeeBenefitNews.com, July 16, 2009

The Senate Health, Education, Labor and Pensions Committee approved a health reform bill on Wednesday that would widely expand coverage for Americans and require employers to ‘play or pay’ for coverage for their employees.

Republicans contended that the bill would only add to the federal deficit and limit the current options available to those already insured. The committee voted 13 to 10, along strict party lines, to approve the bill.
Sen. Christopher J. Dodd (D-Conn.), the chairman of the committee in Sen. Ted Kennedy’s (D-Mass.) absence, lauded the efforts of the bipartisan committee, adding that Kennedy was “ecstatic about our efforts here.”

Republican counterparts were less than thrilled, expressing their discomfort at a public plan that would compete with private plans in addition to the installment of an employer mandate.

“The bill also includes new taxes and mandates on employers that [the Congressional Budget Office] says will cause higher unemployment and lower wages,” said Sen. Michael Enzi (R-Wyo.).

“If you like your job, you should be able to keep it. It’s hard for me to believe that with unemployment nearing double digits, Democrats on the HELP Committee would even consider putting more jobs on the chopping block,” Enzi added. The bill lays the groundwork for a government takeover of health care, creating a government-run health plan that many Americans would be forced onto, and giving Washington bureaucrats the power to ration health care.

The scathing responses to the Quality, Affordable Health Coverage for All Americans bill, which is expected to cost $1 trillion over 10 years and promises to hold significant consequences for employers, has been echoed by many business advocacy groups.

“The most successful and enduring public policies are those that share broad bipartisan support. But the proposal [released on Tuesday] in the House of Representatives and the bill approved [on Wednesday] by the Senate Health, Education, Labor and Pensions Committee, confirm that all hopes now rest with the Senate Finance Committee to produce a health reform measure that can be supported by everyone with a stake in a reformed health care system,” said American Benefits Council President James A. Klein.

A letter signed by 31 organizations, including the U.S. Chamber of Commerce, the Business Roundtable and the National Retail Federation, warned on Tuesday that a government health plan option within a health exchange portal, as is included in the House bill, would kill jobs.

The House measure, America’s Affordable Health Choices Act, resembles its Senate counterpart very closely and comes with a hefty price tag as well. The $1.5 trillion bill would impinge upon employers not offering coverage to pay a penalty of 8% of workers’ wages and provides an exemption for small businesses.

Similarly, the approved Senate-committee bill calls for a shared responsibility of employers, requiring those companies with more than 25 employees who do not provide qualifying coverage or who pay less than 60% of their employees’ monthly premiums are compelled to pay an annual fee of $750 per uninsured full-time worker and $375 per uninsured part-time employee.

Beginning in 2010, employers with 50 or fewer full-time workers who pay 60% or more of their employees’ health insurance premiums would receive tax credits that would subsidize coverage, according to the bill.

Another aspect of the bill, often overlooked, but of critical significance to employers is the extended coverage for dependent adults up to the age of 26, as would be established by the Secretary of Health & Human Services.

Senate majority Leader Harry Reid (D-Nev.) said that he hoped to begin floor debates on both bills a week from Monday, though other officials expect that time table to alter, reports the Associated Press.

In the House, Democratic leaders plan to send the measure through committee and toward a full vote by month’s end. Even if nothing is consecrated in the House or Senate before summer recess, it is clear that a renewed sense of urgency has befallen the Hill.

Source: EmployeeBenefitNews.com, July 15, 2008

In the wellness industry today, incentives are all the rage. Frustrated by low participation in unpopular wellness programs, employers have resorted to offering golden carrots – often valued up to $1,000 per year – to get employees to engage. But why pay people to lose weight, exercise and eat healthier when all that’s really needed to boost participation is peer-to-peer engagement?

It turns out that the same forces currently powering explosive growth in social networking Web sites like Facebook, Twitter and LinkedIn can be harnessed to transform employee wellness programs.

Shape Up The Nation, whose wellness platform is designed to connect employees of all fitness levels with others who share similar interests, has pioneered this innovative approach. The company’s online system enables employees to invite, challenge, track and motivate each other to achieve specific goals through teamwork, friendly competition, and accountability.

“We’re changing the way employers think about wellness programs,” explains Rajiv Kumar, Shape Up The Nation’s managing partner. “Instead of paying people to participate in programs they don’t like, we’ve designed effective interventions that are fun, engaging and encourage them to work together with their friends.”

Money doesn’t always talk

Shape Up The Nation challenges the notion that financial incentives are necessary to change employee behavior, saying it’s not only a costly short-term fix, but may set a dangerous precedent by creating an entitlement mentality.

Employers also must worry about the message they are sending. Paying employees to lose weight, for example, diminishes the true importance of such an effort. When a company offers $500 to fill out a health risk assessment, employees begin to wonder how painful the experience must be in order to warrant that level of compensation. Furthermore, employers risk limiting the benefits of wellness programs by spending excessively on incentives.

Most analyses show companies that invest in wellness programs can save several hundred dollars per employee in health care costs. One study published last year in The Journal of Occupational and Environmental Medicine documented an annual savings of $176 per wellness program participant at health insurer Highmark. If companies spend more than they save, they eliminate their return-on-investment.

It’s a message that surely will resonate loud and clear at a time when employers are hard pressed for cash and trying to control the cost of wellness programs. Instead of focusing on compensation for participation, Shape Up The Nation encourages employers to see the wellness program itself as the incentive.

High participation

As the hundreds of employers who use Shape Up The Nation have learned, the peer-to-peer engagement model creates powerful social incentives for people to participate. Employees are much more likely to join a wellness program when invited by a colleague.

“Instead of singling people out, we are uniting them with the message that all employees share a responsibility for promoting a healthy company culture and, therefore, we must work together,” Kumar says.
Employers that have instituted the Shape Up The Nation program report higher levels of engagement than they have ever seen – up to 50% without incentives. That compares with less than 10% in many online fitness tracking programs and as low as 1% for traditional on-site programs.

A grassroots, peer-to-peer approach to wellness program recruitment also attracts first-timers. At CVS Caremark distribution centers, 84% of participants in Shape Up The Nation reported that it was their first time participating in a wellness program at the company.

Proven outcomes

Kumar and a team of researchers authored a study, published in last May’s issue of the medical journal Obesity, that documented the outcomes of participants in their social networking program. The study found that the average participant reduced body mass index (BMI) by 1.2 points during the first 12 weeks of the program.

To understand the implications of that weight loss on a company’s bottom line, consider a study by Dee Edington, Ph.D., a professor of movement science at the University of Michigan, showing a $202.30 annual savings in employee health claims and pharmaceutical costs for every one point reduction in BMI. That excludes, of course, the significant savings that employers see from increased productivity, morale and retention, and decreased absenteeism, presenteeism and workers’ compensation.

Research on health behaviors spreading within social networks has been a hot topic over the past few years. One prominent Harvard physician, Nicholas Christakis, has published a series of papers examining how health spreads among people who know each other.

Christakis found that when one person quits smoking, his friends and colleagues are more likely to do so as well. When someone loses weight, the individuals in her social network have an increased probability of losing weight, too. Christakis notes that wellness interventions that provide peer support within a social network are more successful than those that do not.

“People are connected – and so their health is connected,” he wrote.

Source: EmployeeBenefitNews.com, July 14, 2009

Leading dental carriers, experts offer employers their wisdom on 14 trends to watch, 9 tips to follow

EBN recently picked the brains of executives at leading dental benefits providers and dental benefits organizations to ask them about what trends they saw emerging in dental benefits over the next several years, and the tips they'd offer to employers to make sure their dental benefits matched those trends.

The recession is affecting all types of benefits - even the once recession-proof dental - so as you might expect, the rise of voluntary offerings and tips for cost-cutting were front of mind. Take their comments under consideration as you plan your strategy for this fall's open enrollment.

Trends to watch

Evelyn Ireland, President, National Association of Dental Plans

1. Impact of health care reform.

While congressional debates on health care reform are centered on the medical system and medical coverage, the results could reshape the entire market for all benefits. Many of the elements of health care reform could affect dental benefits by definition rather than design. Dental is not the intended target, but the industry does suffer collateral damage. Other areas to watch:

• Taxation. Dental benefits are excluded from income of employees' and employers' FICA taxes as they are encompassed in the tax code definitions of health coverage. NADP is working to assure that changes in the tax deductibility of benefits do not have a disparate impact on dental benefits.
• Exchange. If enacted, a health care exchange could offer another avenue for purchase of dental benefits as an optional coverage. 
• Tax credits. Discussion of tax credits for employers that pay a portion of the premium for low income employees (up to 300% of poverty) could be extended to dental benefits as well.

2. The connection between oral health and medical cost savings.

For certain medical conditions and chronic diseases - cardiovascular disease, diabetes and pregnancy - studies continue to provide evidence of cost-savings.

In 2008, the University of Michigan School of Dentistry and the Blue Cross Blue Shield Foundation of Michigan announced findings from an analysis of five years of health claims data showing that for people with diabetes, regular periodontal services can lower overall medical and pharmacy costs by more than 10% and diabetes-related medical costs can be lowered by as much as 19%.

Earlier studies indicate that a person with periodontal disease is up to four times more likely to develop heart disease and has twice the prevalence of diabetes than those without the disease. Pregnant women with periodontal disease are at an increased risk for preterm births and low-birthweight babies.

3. Continued enrollment growth.

Preliminary data from the annual NADP/DDPA Enrollment Study shows a marked increase in enrollment for 2008 - far ahead of the previous years' trend of keeping pace with population increases. Early sales data for 2009 also follow this pattern.

NADP's 2008 Employer Survey, conducted every three years, provides some insight to this trend. Sixty-two percent of employers view dental coverage as essential to their benefits packages, up from 53% in 2005. The largest increase was reported by employers with 250 to 999 employees - a 16% increase since 2005, from 55% to 71%.

4. Comprehensive benefits with key features.

NADP's 2008 Employer Survey found that about 60% of employers with and without dental benefits look first for comprehensive benefits. But they are also focused on a number of key coverages and features within those plans. Five specific features in employee dental benefit plans were targeted by more than 70% of all employers: sealants (77%); benefit rollovers (76%); enhanced benefits for related medical conditions (75%); adult orthodontia (73%); and dental implants (72%).

Tom Dolatowski, vice president of business development, Delta Dental Plans Association

5. Employees will continue to be more involved in the decision to purchase dental benefits, whether covered by an employer-sponsored or voluntary plan, as we are already seeing higher employee contribution levels through voluntary plans, consumer-directed plans and the growth of individual coverage.

6. Plan design innovations will continue the movement toward evidence-based dentistry and higher annual maximum benefits.

7. Carriers will begin to develop performance-based networks.

8. More analysis of members' risk, disease status and use of services, which will help identify at-risk members and members with chronic disease.

9. Continued movement toward fee transparency. More tools will be developed to help consumers compare dentist fees.

Bebe Shuler-Mure, assistant vice president of dental product, Cigna, & Dr. Miles Hall, dental chief clinical director, Cigna

10. Impact of an uncertain economy on budgets of all kinds.

The impact of today's uncertain economy goes beyond what had historically been the compression of the benefits dollar due to rising medical costs. Now, employers and employees alike are seeking options that can help alleviate difficult decisions forced by the economic downturn. These include:

• More affordable plan designs with scaled-back benefits, such as coverage for preventive and diagnostic or Class I-only services, and then access to PPO discounts for services that aren't covered. 
• A renewed interest in dental HMO plans and dental discount plans. 
• Options that allow employers that haven't previously provided dental benefits to offer a low-cost voluntary plan to round out their employee benefits plan.

All carriers are providing options to employers for leaner plan designs to meet their needs for lower price points on all products. We have seen a steady growth of voluntary or low-employer contributory plans even for employers that had historically rich plan designs, in response to the compression of the benefits dollar. Employers are increasingly asking for client-specific networks, where an employer chooses to only provide access to the most cost-effective dental care professionals.

A February survey conducted by Yankelovich for Cigna showed that employees rank dental insurance as one of the important types of insurance to have, so employers should continue to look for ways to offer these benefits.

11.More active participation by consumers.

We continue to see increased interest in rollover-type plans. We also continue to see demand from employers to package together plan designs where employers fund or partially fund a basic plan design, with employees buying up to more robust coverage.

These marketplace changes and the increased focus on prevention have led to a proliferation of consumer decision-support tools; many carriers have recently added cavity and periodontal risk assessment tools to their other online capabilities.

Finally, employers are responding to employee preferences to add coverage for previously non-covered services, such as cosmetic dentistry and implants.

12. Building network capabilities.

Carriers are moving toward segmenting or tiering and leasing third-party networks for greater network reach. Many carriers, Cigna included, provide discounts for non-covered services to people enrolled in the plan. This benefits individuals in several ways.

Specifically, if a person has a preventive and diagnostic only (Class 1 only) plan, or preventive and diagnostic and basic care (Class 1- and 2-only) plan, they can still receive a discount on other services not covered on their plan when they visit an in-network dentist. Expanding network access makes these services more affordable and more widely available. Carriers are also moving toward providing employers with repricing capabilities for those wishing to self-administer.

Chris Swanker, vice president, Guardian Group Dental

13. Stretching annual maximums.

Employers can get more value out of a plan by adding features that will allow them to lower maximums while still offering strong benefits to their employees. Examples of this are plans that rollover annual maximums for future use or allow members to receive preventive care without it being deducted from the annual maximum.

14. Consumer-focused approach.

As employees become used to having higher deductible plans and using tax-favored vehicles, such as HSA and FSAs, to fund out-of-pocket costs, dental plans with high maximums and high deductibles may gain popularity. These plans offer comprehensive benefits at a lower cost.

Tips to follow

Roni Grossman, communications director, Aetna product group

1. Consider providing lower-cost plan options and alternatives, like DMO products, and look for overall value.
Low price is important, but look for an insurer that provides overall value through network access, discounts and superior customer service.

2. Ask for value-added extras.

Not all insurers are the same. Some offer employees access to wellness programs and value-added discounts for members, e.g., fitness, vision, hearing, weight management and other services.

3. Integrate your dental program with your medical program.

Integrating your medical and dental benefits can improve the health of your employees and reduce medical costs over time. Does your insurer use claim information to continually drive education and information to your employees to improve their oral and overall health - or do they just pay claims?

Michael Schwartz, vice president, dental product management, MetLife

4. Rethink plan design.

Many dental benefits plan designs that employers currently have in place may not reflect current research and industry trends, and therefore may not be as cost-effective as believed. There are several ways to re-evaluate plan design:

• Cover at a higher percentage services that prevent and mitigate dental disease, and cover at lower levels services that are more elective. This can help with controlling costs while providing the services employees value.
• Encouraging plan participants to maintain good oral health can help lower overall dental benefits costs for all stakeholders. 
• Review the frequency or age limitations on certain procedures. For example, replacement limits for crowns are typically on 60-month intervals, yet research supports the replacement for these services at twice that interval - 120 months.

5. Offer employees more plan choice.

Some employers that provide dental benefits offer only one plan, and the only choice employees may have is if they want to opt for single or family coverage. However, choice of plans can be very important to employees for improving benefits satisfaction.

A MetLife survey of employees found that approximately seven out of 10 feel that choices in plans are an important feature to have in a dental benefits offering. These choices in plan offerings could be between a DHMO and DPPO. Employees have a lower-cost option with a DHMO, but more coverage mobility and greater access to providers with the DPPO option. Dual options likely will become increasingly prevalent because they can increase employee satisfaction but minimally increase employers' overall dental benefits spend.

For example, two DPPO offerings can also provide employees with greater flexibility such as choices between different coverage levels, deductibles and annual maximums. At any time, but particularly in a tight economy, employees are likely to appreciate being able to adjust their benefits expenditures to their personal situations while still maintaining their oral health.

6. Offer voluntary dental benefits, including for retirees.

Voluntary dental benefits can be a cost-effective solution for many employers. For smaller employers, in particular, who do not yet offer dental benefits, adding voluntary dental benefits may help them compete for talent against larger contenders.

As illustration, 65% of employers with less than 500 employees offer dental benefits, compared to 93% of employers with 500 or more employees, according to the 7th Annual MetLife Study of Employee Benefits Trends.

When considering a voluntary dental benefit, also keep in mind the importance of dental benefits to retirees. For retirees facing financial challenges as well as limited choices for dental coverage, a voluntary dental program where retirees pay 100% of the premium provides them with the advantages of a group program without impacting the employer's bottom line.

Voluntary benefits in general, particularly retiree benefits, will likely continue to grow in popularity among employers because they enable employers to be responsive to their workforce's needs while still controlling cost objectives.

7. Make educational materials available and communicate them effectively.

While it may be stating the obvious, the goal of a dental benefits plan is to improve the oral health of participants. However, MetLife consumer research found that the majority of employees not only feel that they do not have enough information to make dental benefits decisions, but also that oral health information, in particular, is seemingly lacking.

Only 9% of employees reported that materials on oral health are available to them. If the materials are indeed available to employees but they are simply unaware of them, effective communications become even more critical for optimizing the value of the dental benefits plan.

Further, consider the relationship between personal health and personal wealth - specifically, how one's physical well-being may be related to his or her current and future financial situations. According to MetLife's Study of Employee Benefits Trends, employees who said they are in fair or poor health also said they are in worse financial shape than their healthier counterparts. For example, 59% of people who assess their medical health as fair or poor said that they live paycheck-to-paycheck, compared to 34% of people in very good or excellent health. Since certain oral health and medical conditions have been linked, promoting good oral health could have a discernable impact on an individual's overall health and well-being.

Karen Gustin, senior vice president, group marketing, managed care & national accounts, Ameritas Group

8. Investigate your choice of carriers, and ask questions that will position you for future needs.

Benefit and funding options are standard reasons why employers switch, and they can be avoided by upfront creativity and communication with the carrier.

Ask potential bidders what their block of business runs for similar case-size renewals in years two, three and beyond. This will give you an idea of how your renewals may look and how the carrier will manage your dollars.

Nicolas Partridge, president, Pendant Health

9. Make the economy work for you.

Employers are focused on getting to 2010 alive. There is cautious optimism regarding the second half of the year, but most firms are deeply entrenched in cost-savings mode.
 
As such, this is the right economic time to make fundamental changes to employee benefit plans. Not by simply cost-shifting, but rather by embracing plans that encourage employee engagement, healthy behaviors and employee self-management while limiting employers' financial liability.

The dental benefits marketplace provides a unique opportunity to offer creative solutions without the risk inherent with medical claims. As such, employers should investigate: 

• Plans that retain unused premium dollars. 
• Tax-advantaged arrangements like FSAs, HRAs and HSAs. 
• Self-funding.

Source: EmployeeBenefitNews.com, July 28, 2009

HR/benefits professionals hear it all the time: “For a policy or procedure to work, it must have strong backing from upper management. The same can be said for disability management policies and procedures.

“Your CEO is not going to know how to spell ‘disability’ until the company is hit with a million-dollar lawsuit,” joked Robert Sniderman, president of HRFocus USA, during his Monday's session at SHRM’s 2009 Conference & Expo in New Orleans.

Drafting disability management strategies can become tricky business for employers because the process involves creating a course of action that limits liability and lawsuits, while also creating a workplace that values workers with disabilities.

Employers have to make disability management a top corporate concern, which means training senior executives about disability issues within the workplace, explained Sniderman, whose California-based firm specializes in HR management advice.

Take for example, among working-age adults between age 21-64 in the United States during 2006, 21.9% had at least one disability, Sniderman noted. In 2007 and 2008, a significant number of the court opinions involved disability in the workplace issues directly or indirectly.

He believes that the uptick in litigation suggests more awareness of disability rights in the workplace and a willingness on the part of employees to exercise those rights at the expense of the employer.

The ultimate solution for employers will entail implementing solid disability management polices and procedures that will allow the company and employees to fully comply with all leave requirements, related to workers out on disability.

“A good return-to-work system will automatically protect you legally about 95% of the time if you align the system with state and federal disability laws,” Sniderman explained. “Yet, you also have to create a strategy of return to work that is supported by leadership and champion that strategy by becoming informed and promoting it within the leadership suite and down through the ranks of the organization.”

Sniderman urged attendees “to write and embrace a comprehensive return-to-work program and carry it out. Claims when litigated are extremely expensive and difficult to defend without clear policies and procedures.”

In some return-to-work cases, managers may feel the need to review the worker’s medical information, but Sniderman said such a move may color the manager’s outlook on the return-to-work process.

Therefore, “it’s probably a good idea to focus only on the disability information explaining what the worker’s limitations are,” he noted. Do not use doctors, however, to make employment decisions.

Source: EmployerBenefitNews.com, July 2, 2009

Source: EmployeeBenefitNews.com, July 2, 2009

That was the blunt directive for SHRM '09 attendees regarding their HR/benefits policies from Hunter Lott, director of PleaseSueMe.com.

In his presentation, Lott served up tough love for pros on how to reset their policies governing:

* Probationary periods. Eliminate them, Lott said, because they're useless and can bring more legal trouble than they're worth. "You can fire at will, but they can sue at will." Instead, simply keep the "employment at will" statement on the books.

* Exit interviews. Lott said this is an area where pros need to be a lot more creative. "It doesn't make sense," he said. "You're saying, 'The only time we value your opinion is when you're leaving.'" As an alternative, he suggested waiting 90 days to contact former employees.

* Layoffs. In a semantics lesson, Lott advised, "Don't say layoff, because layoff implies callback. If you have a 'layoff,' and then you don't call them when you start rehiring again, they can sue you for wrongful termination." A better, lawsuit-proof term, he said, is reduction in force.

* Performance reviews. Another case of semantics, Lott favors "behavior" over "attitude," since "attitude is not measurable."

* Bans on intraoffice dating. "Why would you say employees can't date?" Lott questioned, adding that it's asking enamored employees to choose: "Which one of you wants to stay, and which one wants to leave and sue us?" He told pros: "Get out of the babysitting business. Change your policy to: 'Any relationship, on or off the job, that affects our ability to do business or your ability to do your job is grounds for firing.' Then handle situations on a case-by-case basis."

Source: EmployeeBenefitNews.com, June 30, 2009

Employers avowing equal benefits for same-sex couples and their families should tread carefully down the aisle in order to sidestep potential tax and legal snags, experts advise.

The concerns might be fewer for self-insured employers generally bound only by federal statutes that do not automatically apply to domestic partners, but all benefit sponsors would do well to stay apprised of related legislative developments in states where they conduct business, where their employees live, and where their insurance provider is based.

Currently, 14 states and Washington, D.C. (see sidebar), legally recognize same-sex relationships. Of these, 10 states require spousal benefits be offered equally to same-sex couples that are recognized under the state's relationship provisions, but only when those benefits are regulated by the state. However, a growing number of organizations are amending their benefits voluntarily to gain a recruiting and retention edge, and also as a matter of social justice. In fact, 57% of Fortune 500 companies in 2008 provided benefits coverage to same-sex couples and families, up from 40% in 2003, according to the Human Rights Campaign.

Employers offering benefits for domestic partners must ensure taxation and imputed income issues are handled properly, that plan documents and employee communications reflect the benefit, and have administrative procedures in place for enrollment, certification and termination of coverage, advises Carol Tavella, senior manager of compensation and benefits at SMART Business Advisory & Consulting.

"We would advise any employer considering offering benefits to domestic partners to check with their insurers, including the stop-loss carriers, because technically they're creating a new eligible class of individuals that is atypical," Tavella explains.

"For insured plans, this is a pricing and underwriting issue, and the carrier may have its own requirements as to administrative procedures or special enrollment forms. Even if they are self-funded, there's usually stop-loss coverage that the stop-loss carrier must be aware of and approve."

Tax considerations

If employers operate in states that require them to provide equal benefits, or they voluntarily choose to expand their definitions of spouse and dependent, they must address the tax implications of changing their plans — the most pressing issue when making the switch, experts say.

Because the same-sex spouse or partner of an employee is not considered a spouse for federal tax purposes under the Defense of Marriage Act, employers must withhold taxes from the employee based on the fair market value of the coverage for the domestic partner and their dependents unless the domestic partner or his or her dependents are dependents of the employee under federal tax law.

In general, a child is determined a dependent if he or she derives 50% or more of their living expenses from the employee, says Susan Stoffer, a partner in the employee benefits and executive compensation practice of Seyfarth Shaw LLP.

"Unless you have a true tax dependent, the coverage of the domestic partner is going to be taxable income to the employee. Also, the domestic partner can't be covered under a flex spending account," explains Stoffer.

Further, same-sex married individuals and those in a domestic partnership who cannot take advantage of benefits funded with pretax dollars are at a great disadvantage compared to opposite-sex spouses.

"One of the most important aspects of state relationship recognition is the taxation of these benefits," says Samir Luther, senior manager of the Workplace Project for the HRC.

"If you provide partner or spousal benefits for someone who is not recognized under federal tax code as a dependent, the value of those benefits must be imputed as additional, taxable income to the employee, which also increases employer payroll taxes. This is a fairly significant burden as it could increase the employee's taxable income by as much as 50%."

Other offerings to consider besides health benefits that are important to domestic partners are the Family and Medical Leave Act, bereavement leave, relocation and travel assistance, education and tuition assistance, adoption assistance, credit union membership, disability and life insurance, and employee discounts.

Retirement plan considerations

For 2010, the Pension Protection Act provides non-spousal beneficiaries the same rollover rights that spousal beneficiaries have.

Until then, businesses must study applicable state laws to figure out whether the domestic partner will be recognized as the de facto beneficiary or whether the company must amend their plan documents and/or beneficiary election forms to have them recognized as such, explains Stoffer.

As the IRS does not recognize same-sex couples as spousal partners for tax purposes, the employer will need to "play with the language governing beneficiary determinations and coverage eligibility criteria" to make that partner eligible to receive benefits.

Understandably, determining beneficiaries under retirement plans can get complicated.

"Federal law now permits any designated beneficiary who receives survivor benefits from a defined contribution plan to roll over the payment into an IRA on a tax qualified basis," clarifies Andrew Sherman, senior vice president at The Segal Company.

"In a defined benefit pension plan, certainly a plan can allow for either preretirement or post-retirement benefits to be provided to any named beneficiary, although plans are only required to provide those benefits to federally recognized spouses."

Most employers offering domestic partner benefits require some sort of substantiation of the relationship, such as an affidavit signed by the employee. Affidavits generally state that the partners are not related, they are both mentally competent, that they live together and that they have not been in any other domestic partnership in at least the past six months.

Many employers also require additional substantiation of the "financial interdependence, such as a joint bank account, a joint lease, joint mortgage or joint car ownership," says Tavella.

Where there are same-gender marriages and civil unions, employers and plan sponsors may wish to require marriage licenses or civil union documentation as alternatives to an affidavit of domestic partnership, which may not be as objective or uniform, says Sherman. Employers should also be consistent in the type of documentation required of opposite-sex married employees.

"With dependent audits, domestic partners and children of domestic partners are treated the same as other dependents, though the documentation may differ based on plan requirements and each plan sponsor's administrative procedures," Sherman continues.

Preparing plan documents

In preparation for all the above modifications, employers should create enrollment forms and develop attestations forms and procedures, says Stoffer.

These documents should be rewritten to redefine the company's definition of a spouse and a dependent, as more often than not employers will include coverage for dependents of domestic partners.

In addition, the employer does not need to post a summary of material modifications until 210 days after the year in which the change is effective, but should inform employees of the change as soon as is practicable so that affected employees will have time to determine their course of action, says Ed Spacapan, a partner with Schiff Hardin LLP.

This information should also be included in the employee handbook and on the company's Web site if possible. Second, management should ensure that the recruiter or hiring staff are aware of this change in case the subject arises.

If employers decide to expand their definition of spouse to include same-sex spouses as well as domestic partners, this should be reflected in all aspects of the company, including work events.

Communicating these changes is imperative if the employer wants to be sure that affected employees are using the benefit correctly and that other workers fully appreciate the equalized workspace the employer is attempting to foster.

Source: EmployeeBenefitNews.com, June 15, 2009

Employers are upping the ante to their wellness programs as the average cash incentive has increased from $204 in 2008 to $329 in 2009, finds a recent study on incentives in corporate wellness programs.

The study, an online survey, involved 372 small, medium and large U.S. companies employing 1.8 million workers.

The value of incentives range from $1 per pound for weight loss to annual premium reductions, the most commonly used incentive, valued at more than $1,500. After premium reductions, merchandise or tokens and gift cards top the list of popular stimuli.

Smaller companies may have limited resources compared to their larger counterparts, but that doesn’t mean they’re skimping on health incentives. Even though a greater percentage of large employers offer programs and incentives, some organizations with as few as 210 employees are offering incentives valued at $1,450 per year, well above average, the study found.

Companies of all sizes are further including spouses and dependents into the fitness fold, with more than half of the 372 companies interviewed offering wellness or disease management benefits to spouses and dependents.

In addition, two out of three companies offer a health risk assessment to employees, and nearly three out of four of those have set up incentives, which range up to $300 annually, with approximately 10% to 15% exceeding $300.

“We are not talking about $5 here or there. We are talking about serious investment into productivity, made by employers with as few as 200 employees, for as much as $1,400 a year per employee. Employers are taking control of health care costs by creating smart, effective new strategies to keep employees healthy, and to keep employees at work,” says Katherine H. Capps, president of Health2 Resources, a Virginia-based health communication firm that sponsored the study with the National Association of Manufacturers.

Moreover, employers are measuring the results from these programs with greater consistency and are finding promising results. In 2007, only 14% of employers measured the ROI of these programs, but two years later 73% are monitoring their results.

Of those measuring, 83% say the programs return better than 1:1 on their investment. As employers’ momentum steadily increases, the friction against program success lessens. Nearly every challenge that employers face has abated over time, including the most difficult task of motivating employees.

Source: EmployeeBenefitNews.com, July 28, 2009

Going green with your workout routine is actually pretty easy to do. Here’s how:

*Get outside. Electrically powered exercise machines at fitness centers and home gyms require a lot of energy to operate. But by taking your workout outdoors, the only energy required is yours. Walking, hiking, biking and jogging are all great cardiovascular activities. Along the way, stop to strength train by using your body weight for resistance with lunges, squats, push-ups, pull-ups, dips and step-ups.

Not only will you get a great workout, you’ll also have lots of fun connecting with the natural world and your community. You can go it alone, enlist a workout partner or even start a workout group in your neighborhood.

*Unplug at home. If outdoor exercise is not an option, try creating a home gym using equipment that, again, requires you to generate the power. Some examples: dumbbells, tubing, kettle bells, jump ropes and self-powered cardio machines such as spinning bikes and rowing machines.

*Dress the part. When choosing your workout clothes and accessories, consider those made of organic cotton, bamboo or other natural fibers -- even coconut shells! You could also look for clothes and shoes made of recycled materials, such as sneakers with recycled rubber soles.

You also can shop for eco-friendly fitness products such as yoga mats made of natural rubber and yoga mat bags made of hemp.

When you’ve worn out your clothes, recycle them. Patagonia, for instance, has a program that allows you to recycle old workout clothes and turn them into new ones. Nike has a recycling program that turns old sneakers into basketball courts, running tracks and playgrounds.

Source: http://fitlist.msnbc.msn.com

Watermelons come in many varieties so you can choose from red or yellow flesh and seeded or seedless varieties. If you will be using the fruit scooped out from the watermelon basket, consider buying a seedless variety. Learn how to cut decorative hearts into a handle for the basket for an elegant but easy edible party decoration or centerpiece. Simply follow these easy step-by-step instructions and fill with your favorite fruit salad recipe.

Note: If you have pumpkin carving tools left over from Halloween, by all means, use them. The watermelon basket handle is for decorative purposes only. Do not use it to lift the basket. It will not support the weight and will break.

You will need:

• Ripe watermelon, seedless or not. Select a watermelon with a flattish bottom so it will not easily roll.
• Large sharp knife. 
• Razor blade knife or craft knife (such as an Exacto® knife). 
• Melon-ball tool (optional). 
• Washable non-toxic children's marker (such as Crayola® brand) in a contrasting color. 
• White paper to draw heart (or other shape) for a template. 
• Small sharp paring knife.

Place the watermelon with the yellow spot, if any, on the bottom and out of view. Be sure it is in a stable position so it will not roll.

• Measure the diameter of the watermelon.
• Find the center and add 1/2 inch. 
• Using a non-toxic marker, mark a line horizontally around the watermelon so you can slice off the top evenly. 
• Before cutting, you will need to trace the handle.
  Cut a stencil of a heart as pictured. The connecting square at the top of the heart is essential for the handle. 
• Position the stencil so the bottom of the heart is about 1/2 inch below the circumference line you have traced on the watermelon. The V at the bottom of the heart will become your starting point for the sword-tooth cut-outs later. 
• Tape on the stencil and use the non-toxic marker to trace the outline.
  Remove and re-position the stencil so that the point of the heart fits into and matches either side of the top square of the bottom heart previously traced on the watermelon. 
• Repeat procedure on the opposite side working up to have the hearts meet in the top center.
  Use a large sharp knife to slice the watermelon in half along the horizontal line up to the traced heart outline. 
• Carve around the hearts at a slight inward angle on both sides. 
• Carefully remove both upper halves of the watermelon. 
• Cut the flesh from the removed halves for use in the fruit salad or other watermelon recipes.
  Use the point of the craft knife to carve an outline of the bottom of the heart down one layer of the skin to the white part. Do not cut completely through or the handle will detach. 
• Carve the centers of the hearts. 
• Slice inward around the rim of the watermelon to remove the flesh. 
• Trim the flesh from the underside of the heart handle, leaving the handle at least 1 inch thick. If you trim it too closely, it will wilt and sag. 
• Wipe off the marker outlines with a clean cloth.
  Begin at the base of the heart and carve a sawtooth border around the rim of the watermelon using a sawing motion. 
• Think ahead to get the points even. Begin on either side of the bottom of the heart point and meet on the far left and right sides. 
• A sharp serrated knife is good for this task. If you do not have one, use a small, sharp, thin-bladed knife.
  Fill watermelon basket with fresh fruit salad or other salad. 
• Do not use the handle to lift the watermelon basket. It will not support the weight and will break.

Source: http://homecooking.about.com